Background: Topical corticosteroids are highly effective compounds that are now widely used in dermatology for the treatment of various autoimmune and inflammatory disorders. Many corticosteroids are misused for diverse indications such as pigmentation, acne, pruritus, fungal or bacterial infections, rashes, and numerous other conditions. These products contain various constituents, most of which have hazards or toxic elements. Objective: The aim is to raise awareness among individuals in the city of Basrah, Iraq about the uses and abuses of applying fake products to the face to inform the consumers about potential harmful adverse effects. Methods: This study was a prospective multi-center clinic questionnaire of a demographic that involved the outpatient dermatology departments at the Al-Basrah teaching hospital and the Abu Al-Khaseeb hospital as well as the private clinics of two dermatology specialists in Basrah. A total of 235 patients with facial dermatoses secondary to the application of topical corticosteroids and counterfeit products or, a mixed formulation, for cosmetic purposes were recruited. Results: Most enrolled patients were female with 10-20 years aged group. The majority applied these products due to friends or pharmacy encouragement. Motivations for the use of these products included: skin fairness, lightening, and general cosmetic. Interestingly, acne and erythema were common whilst, atrophy, dryness, telangiectasia, and hirsutism appear on long- term use only. Conclusion: The abuse of counterfeit cosmetic products and topical corticosteroids is in progress and they have adverse health events. There are many causes behind the abuse but the lack of education, lack of restriction, profitable for sellers and low prices are the main.

Topical corticosteroids (TCS) are the most widely prescribed and abused topical medications worldwide. TCs have melanogenic, anti-pruritic, atrophogenic, immunosuppressive effects on the epidermis and sex-hormone-like, in addition to anti-inflammatory activity. Several of these, if used without judgment, may have serious local and systemic negative repercussions. The current study was designed to evaluate the possible local and systemic effects of topical corticosteroid misuse among women in Basrah City, Iraq. Totally 125 participants were categorized into three major groups: control individuals, patients who utilize TCs for 1–3 months, and patients with long-term TC use for more than 3 months. A questionnaire was filled out, and a full skin examination was performed by a special dermatologist. Blood was drawn for hematological, hormonal, and biochemical analysis. TCS abuse was linked to the development of skin conditions with various percentages and frequencies, such as erythema, photosensitivity, dryness, acne, atrophy, infections, pigmentation, hirsutism, and rosacea. TCs also have systemic adverse effects in addition to their cutaneous ones, especially with prolonged use. TCS elevates RBC and HGB levels significantly compared to control and also prolongs bleeding time. Long-term TCS suppresses ACTH and decreases cortisol concentrations significantly while having no effect on insulin or testosterone levels. Interestingly, TCS significantly reduced serum vitamin D and serum interleukin 6 compared to the normal control group. TCS misuse is a big disaster in Iraq, associated with huge skin impacts and systemic deterioration, including hormonal and hematological consequences that require medical intervention and educational and legal approaches for successful treatment.